On top of PBJ affecting the star ratings, CMS also is performing on-site and remote audits to verify data submitted. Even if you have a vendor submit your data, it cannot be stressed enough: You are ultimately...
Hospices earning high scores on newly released ratings
By
Sep 06, 2017
Hospice providers are showing impressive scores on the Centers for Medicare & Medicaid Services’ new Hospice Compare website — but those high grades have led some to question the site’s efficacy.
Family wins camera case
By
James M. Berklan
Jul 06, 2017
The Minnesota Department of Health ruled against a provider recently in a closely watched case involving a surveillance camera in a resident room.
The Government Accountability Office recently issued a pair of reports within days of one another critical of how the Medicaid program gathers data and screens its provider participants.
Camera policies held up by privacy, litigation concerns
By
James M. Berklan
Aug 06, 2016
In the battle of pros and cons for placing cameras in resident rooms, the potential negative legal and privacy implications are winning out with most providers, new research shows.
Ask the Payment Expert about … expedited review
By
Patricia Boyer
Sep 04, 2015
The expedited review process was developed so a resident could quickly appeal the process if he or she disagreed when a facility decided that a resident is no longer covered under skilled services.
Ask the payment expert … about RACs
Apr 06, 2015
I thought the Recovery Audit Contractors were on hold, so why did I receive a request from our RAC for a Medicare Advantage resident?
Better anti-fraud efforts are not appeasing lawmakers
By
Tim Mullaney
Aug 01, 2014
Long-term care facilities and other Medicare providers increasingly have seen reimbursements influenced by the government’s Fraud Prevention System, an official recently told a Congressional panel.
Penalty process explained
By
Tim Mullaney
May 01, 2014
A long-term care facility that has been slapped with a civil monetary penalty has 10 days to file for an independent informal dispute resolution process, according to a recent manual update from the Centers...
MDS insight found lacking
By
James M. Berklan
Apr 01, 2014
Long-term care staffers’ understanding of the Minimum Data Set and its Quality Indicators is “mediocre at best,” according to recent survey results. Lack of exposure and involvement are...